| NPI | 1477652295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101256788) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 20984) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2021-07-15 |